Recently I had a great chance to participate in the 19th WPA World Congress of Psychiatry which took place in Lisbon 21-24 of August 2019. Such an international scientific event summarizes recent findings and sets a trend for future research.

The effect of lifestyle on mental health was one of the topics discussed at the conference. Focusing on nutritional impact in psychiatry I will review here some of the studies – research done in animal models or patients and literature reviews – which were presented at the Congress.

All the poster presentations can be viewed on the conference website https://2019.wcp-congress.com/.

Dietary patterns and mental health

  1. Sanchez-Villegas and colleagues from Spain1 presented research on the Mediterranean diet’s effects in patients recovered from depressive disorders. They found that adherence to Mediterranean diet supplemented with extra-virgin olive oil led to the improvement of depressive symptoms. This new study supports previous reports about positive effects of traditional dietary patterns compared to so-called “Western diet”, and this topic was nicely reviewed in the poster presentation of M. Jesus and colleagues (Portugal)2.

I presented a poster3 on a study done in a mouse model of Western diet feeding. We found that genetic deficiency of serotonin transporter exacerbates metabolic alterations and such behavioural consequences of the Western diet as depressive-like behaviour and cognitive impairment. In human, carriers of a genetic variant that reduces serotonin transporter expression are known to be more susceptible to emotionality-related disorders and prone to obesity and diabetes.

Vitamin D and Mental Health

Nutritional psychiatry was traditionally focused on the effects of vitamins and micronutrients on mental health. Several presentations at this conference were dedicated to the role of vitamin D in mental disorders.

Scientists from Egypt (T. Okasha and colleagues)4 showed their results on the correlation between serum level of vitamin D and two psychiatric disorders: schizophrenia and depression. They found lower serum vitamin D levels in the patients with schizophrenia or depression compared to healthy volunteers. These findings indicate a role of vitamin D in the development of psychiatric disorders.

However, the team from Denmark (J. Hansen and colleagues)5 did not find any effect of 3 months vitamin D supplementation on depression symptoms in patients with major depression. The contrariety of the studies on vitamin D benefits in mental health was presented on the review poster by R. Avelar and colleagues (Portugal)6.

Microbiome and Mental Health

There is increasing evidence that microbiota-gut-brain axis influences behaviour and mental health. N. Watanabe and colleagues (Japan)7 presented the results of a study on germfree and commensal microbiota-associated mice. They found increased aggression and impaired brain serotonin metabolism in germfree mice.

  1. Dias and colleagues (Portugal)8 performed a literature review on this topic exploring possible effects of microbiome and probiotics in mental disorder development. The most robust evidence was found for the association of microbiome alterations and depression/anxiety. Up to date literature is lacking replicated findings on proving positive effects of probiotics in mental disorders treatment.

Diabetes Type 2 and Mental Disorders

Risk factors for type 2 diabetes include diet and lifestyle habits. It is getting more obvious that there is an association between type 2 diabetes and the development of mental disorders.

  1. Mhalla and colleagues (Tunisia)9 reported a study done on patients with type 2 diabetes. They found a high prevalence of depression in women with type 2 diabetes. Also, depression in these patients was associated with poorer glycemic control.

Depression is an important factor influencing insomnia. H.C. Kim (Republic of Korea)10 found insomnia in one-third of patients with diabetes type 2.

The group from Romania (A. Ciobanu and colleagues)11 created a meta-analysis of the medical literature showing an association of diabetes type 2 with Alzheimer’s disease. They highlighted the role of insulin signaling in cognition and proposed glucose blood level control as a therapeutic approach in Alzheimer’s disease.

 

Thus, a lot of studies were recently done on the role of nutrition in psychiatric disorders development and therapy. However, there is still room for future discoveries!

REFERENCES:
From 19th WPA World Congress of Psychiatry proceedings:

  1. Sanchez-Villegas, B. Cabrera-Suárez, M. Santos Burguete, P. Molero, A. González-Pinto, C. Chiclana, J. Hernández-Fleta. INTERVENTION WITH MEDITERRANEAN DIET IN THE IMPROVEMENT OF DEPRESSIVE SYMPTOMS IN PATIENTS RECOVERED FROM DEPRESSIVE DISORDER. PREDI-DEP TRIAL PRELIMINARY RESULTS;
  2. Jesus, C. Cagigal, T. Silva, V. Martins, C. Silva. DIETARY PATTERNS AND THEIR INFLUENCE IN DEPRESSION;
  3. Veniaminova, A. Gorlova, J. Hebert, D. Radford-Smith, R. Cespuglio, A. Schmitt-Boehrer, K. Lesch, D. Anthony, T. Strekalova. THE ROLE OF GENETIC SEROTONIN TRANSPORTER DEFICIENCY IN CONSEQUENCES OF EXPOSURE TO THE WESTERN DIET: A STUDY IN MICE;
  4. Okasha, W. Sabry, M. Hashim, A. Abdelrahman. VITAMIN D SERUM LEVEL AND ITS CORRELATION WITH MAJOR DEPRESSIVE DISORDER AND SCHIZOPHRENIA;
  5. Hansen, M. Pareek, A. Hvolby, A. Schmedes, T. Toft, E. Dahl, C. Nielsen7, P. Schulz8. VITAMIN D3 SUPPLEMENTATION AND TREATMENT OUTCOMES IN PATIENTS WITH DEPRESSION;
  6. Avelar, D. Guedes, J. Velosa, F. Passos, A. Delgado, A. Corbal Luengo, M. Heitor. VITAMIN D AND MENTAL HEALTH: A BRIEF REVIEW;
  7. Watanabe, K. Mikami, K. Keitaro, F. Akama, Y. Aiba, K. Yamamoto, H. Matsumoto. INFLUENCE OF COMMENSAL MICROBIOTA ON AGGRESSIVE BEHAVIORS;
  8. Dias, I. Figueiredo, F. Ferreira, F. Viegas, C. Cativo, J. Pedro, T. Ferreira, N. Santos, T. Maia. EMOTIONAL GUT: THE RELATION BETWEEN GUT MICROBIOME AND MENTAL HEALTH;
  9. Mhalla, M. Jabeur, H. Mhalla, C. Amrouche, H. Ounaissa, F. Zaafrane3, L. Gaha. DEPRESSION IN ADULTS WITH TYPE 2 DIABETES: PREVALENCE AND ASSOCIATED FACTORS;
  10. Kim. FACTORS RELATED TO INSOMNIA IN TYPE 2 DIABETICS;
  11. A. Ciobanu, L. Catrinescu2, C. Neagu3, I. Dumitru3. THE CONNECTION BETWEEN ALZHEIMER’S DISEASE AND DIABETES

 

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Have you ever heard of the Okinawa Islands, located between Japan and Taiwan, which host one of the longest living people in the world? Even compared with the rest of Japan, to which the islands belong, people grow older on Okinawa.

On average, women become 86 years, men 78 years (1). And more than that, people there maintain a good health up until a very high age. So, what exactly is it that the Okinawans do differently? And what can we change in our lives to get the same positive effects for our health?

Research has extracted many factors that might contribute to this striking longevity, such as a constant moderate physical activity, lack of time pressure and the importance of a solid family structure (see also my blog on effective lifestyle changes here: https://newbrainnutrition.com/four-easy-rules-for-healthy-eating-and-lifestyle/).

What might be easier to change in our everyday lives, however, is the composition of the food we eat.

Let’s investigate what makes the Okinawan diet so healthy (2):

Their diet is rich in root vegetables, especially the very healthy sweet potato. (Who would have guessed that a vegetable carrying the term “sweet” could be more beneficial for your health than its common counterpart?). Sweet potatoes have a high content of dietary fibers, anti-oxidant vitamins A, C and E and anti-inflammatory properties.

They eat many legumes, such as soybeans.

An abundance of mostly green and yellow vegetables is eaten regularly.

Okinawans don’t abstain from meat, alcohol or tea. They consume it in moderation, choosing lean meat and products from the sea.

It seems that no food should be strictly avoided, but that it’s more like the phrase: “Eat everything in moderation and not in abundance.”

Different fruit and medicinal plants (like curcumin or bitter melon) further contribute to a healthy and diverse cuisine.

Altogether, their food is high in unrefined carbohydrates (refined carbohydrates occur e.g. in sweets or white bread, unrefined carbohydrates occur e.g. in brown rice or wholemeal bread) and they consume protein in moderate amounts and mostly plant-based (from legumes, vegetables, but also occasionally from fish or meat).

The Okinawan diet is characterized by a healthy fat profile: rich in omega-3 fatty acids (which occur in fatty fish like salmon, but also in seeds, like flaxseeds, and nuts), high in other polyunsaturated and monounsaturated fatty acids (occurring e.g. in olive oil or avocado, and low in saturated fats (e.g. occuring in butter).

Hence, its composition resembles that of the Mediterranean Diet, which also is associated with a lower risk of cardiovascular disease and other age- and lifestyle-related diseases (Download your free report on the current state of research on the Mediterranean diet here: https://newbrainnutrition.com/the-mediterranean-diet-and-depression-free-report-download/).

By changing our diet and adapting it to the Okinawan (or Mediterranean) diet, you could contribute to a long and healthy life.

Now you might ask how this relates to “new brain nutrition”? Well, a healthy diet affects our gut, which is linked closer to our brain than we originally have assumed (learn more here: https://newbrainnutrition.com/the-gut-brain-axis-an-important-key-to-your-health/​).

Hence, diet should have an impact on our brain health just as on our general health. Substances from fermented soy beans (so-called ​natto), for example, are said to have the potential to prevent the formation of plaque in the brain, which is related to Alzheimer’s disease.

Also, anti-inflammatory effects of a high polyunsaturated fatty acid consumption might have an effect on the production of neurotransmitters (essential for the transfer of information between nerve cells), which largely takes place in the gut.

Interestingly, due to a more western-style cuisine, the younger Okinawans are starting to face the same diseases such as diabetes, high blood pressure, etc, just as people from the rest of the world.

Diet matters. So: What changes in your diet do ​you​ want to start with?

Take the first step and try a typical Okinawa dish: Goya Champuru

1 Goya cucumber (may also be frozen)

1 block tofu, dried and as firm as possible approx. 80-100g

Shabu-Shabu meat (thinly sliced pork); cut meat into bite-sized pieces

1-2 tablespoons soy sauce

1-2 tablespoons rice wine (sake)

1/2 teaspoon salt

2 tablespoons neutral oil (must be suitable for frying!)

2 eggs

For vegetarians: Follow the same recipe, but replace Shabu-Shabu with chopped vegetables like carrots, onions, cabbage and bean sprouts or pumpkin.

Wash the Goya cucumber, cut it in half and remove the seeds with a spoon. Slice thinly, salt it, let it rest for a few minutes. Wash again, press firmly to remove as much water as possible.

Stir-fry the Shabu-Shabu in a tablespoon of oil, salt it afterward.

Add tofu and stir-fry it until it turns slightly dark. Put tofu and Shabu-Shabu aside.

In the same pan, heat another tablespoon of oil and stir-fry the Goya cucumber in high temperature.

Add the meat and tofu, then soy sauce and sake, stir.

Scramble two eggs and add them.

Stir and don’t let the food turn too dry.

Serve the Champuru with rice.

REFERENCES
(1) https://de.wikipedia.org/wiki/Präfektur_Okinawa

(2) Willcox DC; Scapagnini G; Willcox BJ. Healthy aging diets other than the Mediterranean: a focus on the Okinawan diet.Mech Ageing Dev. 2014; 136-137:148-62 (ISSN: 1872-6216); found here: https://www.sciencedirect.com/science/article/pii/S0047637414000037

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Download your FREE REPORT

New research has been published in September 2018 which reveals preliminary evidence that symptoms of depression can be reduced by adherence to the Mediterranean diet and anti-inflammatory foods.  New Brain Nutrition is advancing this research with never-before-done clinical trials testing the protective effects of nutrition and specifically the Mediterranean diet.

You can download our FREE REPORT, learn what we know now, and then be updated on our progress as the clinical trials produce results.

Download your free report today!!

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Mediterranean diet could prevent depression, new study finds” [CNN]; “Mediterranean diet ‘may help prevent depression‘” [BBC]. The publication of Lassale and her colleagues in the prestigious scientific journal Molecular Psychiatry on the association between Mediterranean Diet and depression, received a lot of attention in the media last week.

So, can diet really influence your mental health? The publication of Lassale shows that there are indications that what you eat is related to how you feel. But because this study is an observational study, we can’t conclude anything yet about causation. In other words, we don’t know yet whether eating healthy causes you to feel less depressed, or whether feeling depressed causes you to eat unhealthy.

Causal links between diet and mental health

Diet and mental healthThe researchers of the European consortium Eat2beNICE are investigating exactly this causal link. The way we do this is through clinical trials. In this way, we first let chance decide whether a person receives a particular diet or is part of the control group. Through this randomization we can be sure that the differences that we find between the two groups are really due to the dietary intervention that people received, because all other factors are the same between the two groups.

Specifically for the effects of the Mediterranean diet on behaviour, in the Eat2beNICE project we are using the information and measurements available from the PREDIMED-PLUS trial. In this study, we are looking specifically for the effect of a calorie-restricted Mediterranean diet, combined with physical activity, on several behavioral outcomes related with several psychiatric diseases of adults at high cardiovascular risk.

At the same time, we are conducting three other clinical trials:

  1. In Nijmegen (The Netherlands), we investigate the effects of a very strict, hypo-allergenic diet on behavioural problems in children with ADHD.
  2. We are investigating the effects of vitamin supplements in a clinical trial that will be conducted in Mannheim(Germany) and Groningen(The Netherlands).
  3. Researchers in Barcelona (Spain) and Frankfurt (Germany) are investigating the effects of probiotics (i.e. bacteria that are good for you) on mental health in adults that are highly impulsive and/or aggressive.

Through these studies we hope to be able to identify if these types of food improve mental health and in which circumstances. This can have big implications for psychiatry, where putting someone on a specific, personalised diet may be a way to improve treatment. Also, people who are at a risk for developing mental health problems may benefit from specific diets to reduce this risk. But before this can be put into action, we first need good scientific data on what really works.

How can food drive human behaviour?

A second aim of our large research consortium is to identify the mechanisms between nutrition and the way the brain works. We think that the bacteria that live in your gut play a large role in this, as they interact with other systems in your body, including your brain. So we are collecting poop samples of the people that are participating in our clinical trials to identify which bacteria are more or less common in our participants compared to the control population. We are also measuring our participants’ behaviour and we will scan their brains. We hope that this will help us understanding better why certain types of food can be beneficial for mental health, and why some others increase the risk for mental health problems. This too will help to elucidate, and understand, the causal links between food and behaviour.

In short, we are very thankful for the study of Lassale and her colleagues, for backing up the evidence that what you eat is related to how you feel and behave. Now there’s work for us to do to prove the causal and mechanistic links. We’ll keep you posted here!

 

Authors Jeanette Mostert and Alejandro Arias-Vasquez work at the department of Genetics at the Radboud University Medical Center in Nijmegen, The Netherlands. Alejandro Arias-Vasquez is the project coordinator of the Eat2beNICE project. Jeanette Mostert is the dissemination manager.

 

Further reading

Lassale C, Batty GD, Baghdadli A, Jacka F, Sánchez-Villegas A, Kivimäki M, Akbaraly T. Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies. Mol Psychiatry. 2018 Sep 26. doi: 10.1038/s41380-018-0237-8.

 

Blog by Jordi Salas explaining the Lassale paper and the PREDIMED trial:
http://newbrainnutrition.com/category/nutrition/mediterranean-diet/

Blog by Jolanda van der Meer on hypo-allergenic diet (TRACE study): http://newbrainnutrition.com/adhd-and-food-elimination-diet/

Blog by Julia Rucklidge on trials with vitamin supplements: http://newbrainnutrition.com/micronutrients-and-mental-health/

Blog by Judit Cabana on the Gut-Brain axis: http://newbrainnutrition.com/the-gut-brain-axis-how-the-gut-relates-to-psychiatric-disorders/

 

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Constantly feeling low mood and blue, losing of pleasure in life and appetite or having difficulties to have good sleep.

These are just some of the symptoms of one of the most prevalent mental conditions worldwide: depression. It affects hundreds of millions people globally, particularly women. Although depression seems to have a genetic component, lifestyle factors like diet have been suggested to play possible roles in the development of this condition and the degree of their symptoms. In fact, many different studies have suggested that different healthy diets may have important benefits for depression.

did i eat thatIn a recently published meta-analysis at the prestigious scientific journal Molecular Psychiatry, Lassale and coworkers aimed to summarize current epidemiological evidence in relation to healthy dietary patterns and depression. They included a total of 41 high quality observational studies conducted in healthy people from different countries, focusing on several types of well-known healthy dietary indices: Mediterranean diet, the Dietary Approaches to Stop Hypertension (DASH) diet, the Healthy Eating Index (HEI) and Alternative HEI (AHEI), and the Dietary Inflammatory Index. These healthy dietary indices score favorably for the consumption of different “healthy” foods, such as fruits and vegetables, nuts, cereals, legumes and healthy fats; and they penalize the consumption of “unhealthy” foods, such as processed foods.

The main findings of the Lassale meta-analysis revealed that those persons following more closely the Mediterranean diet, and those following less the pro-inflammatory diet, showed lower risk of depression and depressive symptoms. Similar beneficial results were observed with a high adherence to the HEI and AHEI diets, yet the evidence was not as strong as with the Mediterranean diet. Indeed, the dietary patterns evaluated in this study contain foods and nutrients which may modulate important biological processes related with depression. For example, healthy diets may reduce oxidative stress and inflammation processes, improve insulin sensitivity and blood circulation in the brain.

These important findings give a strong basis to the role of healthy dietary patterns like the Mediterranean diet in preventing depression and depressive symptoms, and they contribute to build future dietary recommendations to prevent this mental condition.

However, as the authors comment, it is important to keep in mind that all the studies included are observational, meaning, it is not possible to establish causal effects between diet and depression.

To establish causality that can be used to directly translate the knowledge into clinical practice, science needs specific intervention studies. In these studies, a healthy diet is followed for a long time and depression incidence is evaluated.

An example of this is the study conducted in the frame of the PREDIMED study with a population of Mediterranean adults at high cardiovascular risk. In this study, participants consuming the Mediterranean diet supplemented with nuts showed 41% protection against depression, although these benefits were only observed in people with diabetes. In view of the PREDIMED-Plus trial, a multicenter study is being conducted in Spain for the primary prevention of cardiovascular disease using an intensive lifestyle intervention. It will be possible to confirm these results and have new knowledge in the field of depression. With PREDIMED-plus, the investigators will be able to evaluate whether an energy-restricted Mediterranean diet,  with promotion of  physical activity, may be effective for reducing the risk of depression in elders at high cardiovascular risk. In case of the Eat2BeNice study we plan to analyse in the future the effect of PREDIMED-PLUS interventions not only on depression but also on mood and especially on impulsivity and compulsivity, two important domains related to brain function.

Overall, following a healthy diet, like Mediterranean diet, not only has important benefits for different aspects of human health but also it is likely that the diet prevents depression,  depressive-related symptoms and possible other mental related conditions. For this reason, a healthy diet nourishes a healthy mind.

 

References

Lassale C, Batty GD, Baghdadli A, Jacka F, Sánchez-Villegas A, Kivimäki M, Akbaraly T. Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies. Mol Psychiatry. 2018 Sep 26. doi: 10.1038/s41380-018-0237-8.

Sánchez-Villegas A, Martínez-González MA, Estruch R, Salas-Salvadó J, Corella  D, Covas MI, Arós F, Romaguera D, Gómez-Gracia E, Lapetra J, Pintó X, Martínez JA, Lamuela-Raventós RM, Ros E, Gea A, Wärnberg J, Serra-Majem L. Mediterranean dietary pattern and depression: the PREDIMED randomized trial. BMC Med. 2013 Sep  20;11:208. doi: 10.1186/1741-7015-11-208.

 

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